Healthcare Provider Details

I. General information

NPI: 1487382008
Provider Name (Legal Business Name): ROBERT ALLAN WELLS DNP, FNP-C, ENP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 ROLLING MEADOW DR
DAVISBURG MI
48350-2953
US

IV. Provider business mailing address

6787 ROLLING MEADOW DR
DAVISBURG MI
48350-2953
US

V. Phone/Fax

Practice location:
  • Phone: 248-872-8556
  • Fax: 248-328-6122
Mailing address:
  • Phone: 248-872-8556
  • Fax: 248-328-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704291642
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number4704291642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: